Professional continuous glucose monitoring for the identification of type 1 diabetes mellitus among subjects with insulin therapy
Journal
Medicine (United States)
Journal Volume
94
Journal Issue
3
Pages
e421
Date Issued
2015
Author(s)
Abstract
The identification of type 1 diabetes in diabetic subjects receiving insulin therapy is sometimes difficult. The purpose of this study is to evaluate whether results of professional continuous glucose monitoring can improve the identification of type 1 diabetes.From 2007 to 2012, 119 adults receiving at least twice-daily insulin therapy and professional continuous glucose monitoring were recruited. Type 1 diabetes was diagnosed by endocrinologists according to American Diabetes Association standards, including a very low C-peptide level (<0.35pg/mL) or the presence of diabetic ketoacidosis. Continuous glucose monitoring was applied for 3 days.Among 119 subjects, 86 were diagnosed with type 1 diabetes. Subjects with type 1 diabetes were younger (33.8 vs 52.3 years old, P<0.001), had lower body mass index (BMI, 21.95 vs 24.42, P=0.003), lower serum creatinine (61.77vs 84.65μmol/L, P=0.001), and higher estimated glomerular filtration rate (108.71 vs 76.48mg/mL/min/1.73m2, P<0.001) than subjects with type 2 diabetes. Predictive scores for identification of type 1 diabetes were constructed, including age, BMI, average mean amplitude of glucose excursion in days 2 and 3, and the area under the curve of nocturnal hyperglycemic and hypoglycemic states. The area under the receiver operating characteristic curve was 0.90. With the cutoff of 0.58, the sensitivity was 86.7% and the specificity was 80.8%. The good performance was validated by the leave-one-out method (sensitivity 83.3%, specificity 73.1%).Professional continuous glucose monitoring is a useful tool that improves identification of type 1 diabetes among diabetic patients receiving insulin therapy. ? 2015 Wolters Kluwer Health, Inc.
SDGs
Other Subjects
C peptide; creatinine; glucose; insulin; antidiabetic agent; creatinine; glucose blood level; insulin; adult; Article; blood glucose monitoring; body mass; continuous glucose monitoring; controlled study; creatinine blood level; diabetic ketoacidosis; diagnostic test accuracy study; endocrinologist; female; glomerulus filtration rate; glucose sensor; human; insulin dependent diabetes mellitus; insulin treatment; major clinical study; male; middle aged; non insulin dependent diabetes mellitus; priority journal; sensitivity and specificity; adolescent; aged; blood; child; comparative study; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; differential diagnosis; dose response; glucose blood level; metabolism; physiologic monitoring; physiology; procedures; regression analysis; retrospective study; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Blood Glucose; Body Mass Index; Child; Creatinine; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diagnosis, Differential; Dose-Response Relationship, Drug; Female; Glomerular Filtration Rate; Humans; Hypoglycemic Agents; Insulin; Male; Middle Aged; Monitoring, Physiologic; Regression Analysis; Retrospective Studies; Sensitivity and Specificity; Young Adult
Publisher
Lippincott Williams and Wilkins
Type
journal article